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Sunday, May 30, 2010

Extended case study of Tyler youth who slayed special ed teacher

The Dallas News has published an excellent, extended article by Lee Hancock on the sad case out of Tyler where a mentally ill youth named Byron who was hearing voices stabbed his special ed teacher, Todd Henry, at John Tyler High. I'd refrained from commenting on this high-profile case because we knew so little about the youth and the situation beyond the bare facts of the murder, but now Hancock has provided a wealth of detailed background. Here's a notable excerpt:

bureaucrat after bureaucrat seemed bent on making a deranged child someone else's problem. Byron was pushed from school to treatment center to prison and back in a pattern that, on paper, looks like treatment by transfer.

Official fears about what Byron might be capable of went largely unshared until Henry died. Fragmented educational, mental health and justice agencies appeared incapable of communicating with one another, even after state psychologists declared Byron too sick for juvenile prison and unstable enough to warrant locking up every knife in his family's home.

"I'm not mad at Byron. I just want him put where he can't hurt anyone ever again," said Henry's widow, Jan. "I'm angry at the system. It failed Todd. The system put [Byron] in my husband's classroom. Todd didn't have a chance. And that can never, ever happen again."

"He hasn't just fallen through the cracks. The system keeps throwing him through the cracks," Huggler said. "Everything set up to prevent what happened to Mr. Henry was broken."

Experts say such disconnects are sadly common. The head of a Michigan juvenile agency recently told Congress that the problem of juvenile offenders getting little coordinated care until they commit horrific crimes is "the hidden secret that nobody wants to talk about."

Granted permission by Byron's mother to access his official records, the News found that:

The agency forms, memos and reports – a five-foot pile of paper that weighs 70 pounds – trace a descent into chaos. From his arrival in Texas as a Hurricane Katrinaevacuee until his arrest for Henry's slaying, records show that Byron had:

• 10 transfers in 18 months in TYC. That included three trips to the unit for the most disturbed juvenile offenders and a mental hospital stay.

• Treatment by at least 10 psychiatrists who prescribed six drugs, including four antipsychotics. Eight psychiatrists saw him in TYC.

• Cycles on and off psychiatric drugs. Byron was taken off drugs for 82 days by TYC psychiatrists who declared he didn't need any treatment. When he refused medications, some TYC psychiatrists instituted a bizarre punishment. They ordered all drugs withheld, sometimes for weeks at a time. Juvenile justice and psychology experts call that practice unconscionable.

The notion that TYC psychiatrists took the boy off his meds as punishment reaches beyond the "bizarre" to gross incompetence or intentional negligence. Any medical professional who was aware of that practice and didn't object should be fired and pilloried. Yesterday.

FWIW, in 2007 about the time this boy entered the system, Ben Raimer from UTMB was telling the Legislature that the quality of mental health treatment at TYC had declined because of the loss of key staff, underfunding by the state, and a "chaotic" environment. So there's a very real extent to which the Lege shares responsibility with the bureaucracy: They were told mental health services for such youth were inadequate and declining, but rectifying those problems always seemed pretty far down the priority list during debates dominated by allegations of staff-on-youth sexual assault.

There are many other remarkable implications to this story. (A sidebar identified possible reforms suggested by the incident.) The entire, lengthy article is worth reading in full as a case study of the consequences of relegating mental health treatment to carceral institutions instead of hospitals or community-based assistance. Too many mentally ill offenders are passed from bureaucracy to bureaucracy just like Byron instead of getting focused or effective help. In that sense, this story is a painfully common one, differing only from so many thousands of others in its spectacularly tragic denouement.

I don't see the taking him off of medication as such a big deal. Most of that medication isn't very effective anyway. In fact, sometimes I think it causes the very things it is supposed to be helphing (look at the side effects of these medication). I bet he was on medication when this happened and it didn't prevent it. Psychiatrist need to start facing the truth about the ineffectiveness of current treatment methods and start developing and using other non-drug treatments.

For example, ECT is the safest and most effective treatment for some types of psychosis. Yet, if it is considered it is only as a last resort. ECT got a bad rap in past decades because it was abused. But, now it has been refined and is very safe and effective. In fact, a few years back I read a Johns Hopkins white paper on depression that said ECT was the safest and most effective treatment for pregnant women suffering from depression. A psychiatrist once told me that when psychatrist have problems with depression, ECT is the first thing they dao. But, if a psychiatrist were to refer a patient for ECT, they lose a patient and don't get to collect all that money for writing prescriptions. No one can say for sure, but if this kid had gotten ECT, there's a good chance this never would have happened.

Psychiatry's continued reliance on ineffective and sometimes dangerous drugs as the primary, and often only, form of treatment has resulted in other deaths, as well as the one that is the subject of this story.

In Sept. 2008, the lege placed mental health care with all medical and UTMB was in charge from that point on. Most mental health care was either a contract Dr. who didn't know rules or a doc in the box through telemedicene.TYC didn't prescribe,issue nor withold meds.

11:44, he went off his medications before the event. I agree meds aren't the end-all be-all solution, but neither do I think electroshock therapy should or will be used anytime soon in a corrections environment.

Tragic. At what point are we going to give mental health care in this country the same level of recognition, priority and importance as all health care? A child with cancer would not be shuffled around and transferred to 20 different doctors, hospitals, etc. and still not receive the treatment he needs.

So you prefer to use the more dangerous and less effective treatment methods. Do a little research and you will see that many of these medications are much more dangerous in the long run than ECT. Look at the studies on them and you will see they are much less effective than ECT. So, lets just keep using the most dangerous and lease effective treatment methods.

I'm not saying anyone should be forced to undergo ECT but they should be given it as an option and they should be told the truth about its risks and effectiveness compared to the risks of long term treatment with medications.

Part of the problem is just plain ignorance. ECT is used regularly in some hospitals, including the hospital in Dallas run by the Southwestern medical school, I can't remember the name of the hospital right now but its said to be one of the best in the state. It's also done at Terrell State Hospital.

But, when you ask some supposed mental health professionals about it they know nothing beyond what it was like in the 70's.

So, to get the most effective treatment you either have to have the insurance or money to afford good private hospital that does it or be lucky enough to end up at Terrell. Again, I'm not advocating forceing anyone, but, should anyone be denied the most effective and safest treatment.

If you had cancer and the doctor failed to recommend the most effective and safest treatment and instead only offered a much less effective and more dangerous treatment. Wouldn't you think that was malpractice? Why is it not malpractice when a psychiatrist does it?

3:21, Meds shouldn't be denied for punishment just as electroshock shouldn't be used for punishment. You saying you have no problem withholding meds for that purpose dramatically undermines your credibility, no matter how much you dislike antipsychotic medication.

I just looked up some of the research on ECT as used for psychosis. According to this source, a metastudy of 26 clinical trials, "The evidence suggests that courses of ECT can, in the short term, result in an increase in global improvement for some people with schizophrenia." However, "The effects of its use in people with schizophrenia are unclear." And "there is no evidence that this early advantage for ECT is maintained over the medium to long term."

Concludes the researcher: "The research base for the use of ECT in people with schizophrenia continues to expand, but even after more than five decades of clinical use, there remain many unanswered questions regarding its role in the management of people with schizophrenia."

IMO based on that analysis you're significantly overstating the benefits from electroshock therapy. And in a corrections environment there are additional concerns over a tactic that can be and has been misused, and serious questions about implementing it in an environment with generally low levels of medical supervision and quality of care.

Really? Really, there are attorneys in Tyler that actually defend their clients.... Please name ONE.

Having personally reviewed the outcomes of multiple criminal cases stratified by attorney, I have found that most attorneys only plea their clients out or find their clients traveling on down the road in a white bus - you know the one without the windows.

Name ONE attorney that will take a case to trial.... Oh, while you are at it, please explain how those attorneys ended up with nicknames like - MAXIMUM xxxx.

"The notion that officials took him off his meds as punishment reaches, IMO, the level of assault." From where does the reporter draw the conclusion Byron's medications were removed for "punishment?" That word is not used in TYC, at least in writing. TYC treatment specialists would never use that word. The article shows that Byron refused medications throughout his life, no matter what entity was trying to help him. Most of the kids don't like to take their medications, and I don't think any TYC facility can force a student to take them. They can only ensure that he doesn't cheek the medications he's handed. Only a psychiatrist can change medication orders, and why would TYC psychiatrists want to "punish" a student? Contractors don't do direct care. There would be no motivation for any TYC employee or contractor to withhold medication solely as "punishment," because the medication helps regulate behavior.If Byron steadfastly refused medication for days or weeks and his behavior didn't seem worse, a psychiatrist might discontinue the order. I remember instances when a student made a verbal commitment to the psychiatrist to behave better in exchange for not having to take medications he dislikes.

Now and never was TYC equipped to deal with serious mental illness. We've always known that, but mentally ill children are sent to ("dumped on?") TYC regularly because everyone else has given up. I think this sad story has been used in part by the media and others to dump on TYC people again, and as always TYC is unable to defend itself.

XTYC, A high-school teacher was murdered. The focus on this case isn't because of some secret media desire "to dump on TYC people." That mentality is poisonous: The answer to every criticism cannot be defensiveness and a paranoid (false) belief that everyone is out to get the agency, which brought most of its woes on itself.

You write: "Now and never was TYC equipped to deal with serious mental illness. We've always known that, but mentally ill children are sent to ("dumped on?") TYC regularly because everyone else has given up."

This is true, but it doesn't absolve TYC (or UTMB). TYC may not be equipped to handle mentally ill youth, but since they're responsible for them they should become equipped. The Lege hasn't given the resources, but I'd also add that TYC hasn't typically made the case for them during the budget process - at least the last couple of sessions when the focus was more on security, closing units, diversion programs, etc.. TYC's mental health services are, by all appearances, flailing in a state of absolute crisis. And it's not all because those mean, nasty TYC haters are ganging up on you.

I'm confused. If this child was so mentally ill, why on earth was he not parked at the mental health unit the entire time he was at TYC, rather than being transferred around? During each of his "three trips to the unit for the most disturbed juvenile offenders" (CRTC, I assume), he would have had to be assessed by the psychology department, and ultimately determined to be stable enough to return to general population (i.e., the campus from whence he came.) How then does one suddenly be deemed "too sick for juvenile prison" and released? I understand the concept of instability and variation in mental illness presentations, but please! 3 assessments in 18 months determining he's not ill enough to stay at CRTC, and then suddenly he's too ill to complete the TYC program? What am I missing?

TYC's mental health program is not a real program. It should be no surprise that it has now been exposed for just how sad the program is. Many youth have been misused by this section of the wild uncontrolled agency.

I never said I was okay with withholding the meds as punishment. I was just saying that the meds are so ineffective, I don't think withholding them makes much difference. You need to do a little more research on ECT. As a journalist you should know that one source is not enough to understand a subject. Like I said before, the Johns Hopkins (which is very well respected) white paper on depression recommended it as the safest and most effective treatment for pregnant women with depression. You will find a lot of negative stuff out there about it but most of it is not based on current knowledge and experience. Talk to some of the psychiatrist with UT Soutwestern that perform it.

I'm realy shocked at you grits. I admire your blog. But, you really should be more thorough than just relying on one negative source for information. If you thoroughly research the subject will find what I am saying is true. For many people it is the safest and most effective treatment. Don't just limit your research to schizophrenia. Its also very useful for people who suffer from psychosis with depression and other types of psychosis that may not be full blown shizophrenia.

The side effects of many of these meds are much more dangerous in the long term than ECT but you have no problem with them being prescribed. You should do a little research on them. You would be shocked. For example, Zyprexa significantly increases risk for developing diabetes. If given the choice would you rather have ECT or diabetes? Some of the antipsychotics can cause permanent and disabling movement disorders. Some of them can actually cause psychosis (look at the side effects).

The research (if you will bother to look at more than one source)clearly shows that ECT is much more effective than medication. (That's why doctors and UT Southwester prescribe it) Many patients continue to take meds after ECT but at a much lower dose which decreases the risks from side effects.

Furthermore, the fact that it is more effective makes it more cost effective also. Many of these meds are expensive. Patients who have had ECT require fewer hospitilizations and less meds. So, not only would it be better for the patient, it would save the state money.

I've worked with kids on significant doses of these medications and watched a family member struggle with a serious mental illness. The medications are ineffective and dangerous. Even if ECT isn't an option, its time for pyschiatrist to start looking for treatments that work and quit relying on the same old ineffective and dangerous treatments.

I challenge you Grits, to look at all the information on ECT and compare it to the information on the mdications. You will see that I'm right.

Furthermore, this kid received a lot of treatment, including outpatient treatment, so we are not just talking about a corrections environment. I would bet at some point he received treatment from the Andrews Center. The typical treatment they provide is a 15 minute session with a psychiatrist once every 3 months. That psychiatrist may have the child on 3 or 4 different medications. It's all guess work. They don't really know what these meds do, they have only theorized about what they do by observing the effects. They sure don't really know what happens when you mix 3 or 4 of them together. A lot of times they just prescribe whatever the drug reps are pushing that month.

"3:21, Meds shouldn't be denied for punishment just as electroshock shouldn't be used for punishment. You saying you have no problem withholding meds for that purpose dramatically undermines your credibility,"

Your putting words in my mouth. I didn't say either of those things. I said I didn't see it as a big deal because the meds are not effective, not because it should be used as punishment. Furthermore, I never said ECT should be used as punishment. In fact, if you will read what I wrote you will see that I said no one should be forced to do it.

I'm simplly advocating that people be provided with the option of having the safest and most effective treatment. What is so bad about that?

Grits, here's a good place to start your research (I'm sure you'd agree Johns Hopkins is a credible source): http://www.hopkinsmedicine.org/psychiatry/specialty_areas/brain_stimulation/ect/

Here is a quote from the site: ECT is a safe and effective treatment that involves passing a carefully controlled electrical current through a person’s brain to trigger a seizure — a rapid discharge of nerve impulses throughout the brain. In recent years, the National Institute of Mental Health, the American Psychiatric Association, and the U.S. Surgeon General all endorse ECT as a valuable tool in the treatment of certain psychiatric disorders, and major depression in particular.

Taking a mentally ill person off his meds is so beyond the pale that I'm at a loss for words. "You behaved poorly, so now you can't be sane for a length of time". This is sadistic torture. Plus, these people aren't "actors" anny 8, they are people. This isn't a movie, this is real life, where people suffer, bleed, and get hurt. I despise the way the le culture moves ever closer to marginalizing the very people who it was created to serve.

Grits, it does appear that TYC has continues to be a convenient target, and this article is an example. Mr. Kiker is a regular commenter, and in the first post, he pronounced TYC guilty of assault after reading the article! Good grief!

I said that TYC would have had no reason to discontinue medication that helped the youth control his behavior. And the contract psychiatrist wouldn't have been looking to "punish" the youth. That was used by the reporter as criticism of TYC, and I think it might have been unfair and probably untrue. TYC has never been an appropriate place for the truly mentally ill, and everyone has known that for decades.You are right -- the focus of the article is on why the teacher died. Is TYC to blame for the death? We agree that TYC isn't equipped to handle mentally ill youth, but at least while he was at TYC, he wasn't committing murder. Yet, a questionable criticism of withholding medication as "punishment" is okay? You probably know the reporter. Ask him/her about it. Don't do it for little ole defensive, paranoid me. Do it for all of the parents whose mentally ill children might be headed for TYC.

2:45, I didn't look at just one negative source. I looked at several sources and chose to cite a metastudy that compiled results from 26 different clinical trials. You're the one who appears to only want to rely on studies that agree with you and discount any that don't. You've found one Johns Hopkins white paper that agrees with you and don't appear interested in looking any further.

I'll keep an open mind, but I'm not a clinician and the medical profession must evaluate the efficacy of such treatments. I'm not equipped to do it.

XTYC writes, "at least while he was at TYC, he wasn't committing murder." Except TYC then released him with no supervision and didn't adequately inform locals about his behavior. I don't want to be piling on, but under those circumstances TYC MUST accept some responsibility.

I hate to say this, but TYC at one time had a doctor who would take the kids off their meds for not coming to see him when they had an appointment. Believe it or not, don't care, know it's true! Everyone else at CRTC knows it is a fact! It was a big issue out there at Treatment Teams meetings all the time with staff that were present at these meetings. You choose to believe it or not, don't care, I am not there anymore.

This is a sad turn of events with enough blame to go around. All of the agencies and programs failed the youth, his family, and the teacher. I fear the system will continue to fail him if he is tried and convicted and sentenced to prison rather than a treatment facility. The public should be outraged that even now following the murder of an innocent teacher, no one has stepped up to take responsibility. My prayers go out to the families.

This conversation is getting down to small and fairly meaningless anecdotes, 8:10 (and 8:52), but I have to ask what doctor wants to prescribe medications without the opportunity to actually see the patient?

9:26 What doctor would take mental ill kids off meds they were already on to treat them? You know ,its one of those You just had to be there to understand it. Not going to debate it. All he did was make the situation worse for all involved including the kid. Its easy to judge when you read about things, but easy to understand the situation when you have experienced it. Sorry you feel its not important message.

If I am correct, this youth was discharged from TYC under HB1550 because he was too mentally ill to receive treatment from TYC. It is my understanding that HB1550 is very clear that TYC should ensure that the youth at discharge is linked to appropriate mental health services and/or possible committment to a mental hospital. If my information is correct, this never occurred, which in my opinion makes TYC negligent and liable for the death of the Tyler ISD teacher.

on another note, this kid had a caseworker that had No experience being a caseworker. She was rifted from one job in the school and placed in a caseworker position. She had worked her entire life as a teacher aide. Talk about good qualified personal working in such an important role for kids. Why would you have someone with the lack of experience in casework working with a kid that was so mentally unstable or any kid out there?? Really sad.

This is nothing new. TYC has a miserable history of youth treatment, or mistreatment. There is always fifty excuses for their screw-ups and its always others that are to blame. Sue the hell out of TYC and its inadequate and superior minded-negligent staffers. It will never end until TYC is held strictly accountable for their endless mistakes and gross mismanagement.

If I have said it once, I've said it a thousand times. Flush the commode already! TYC is a total loss. Flush it and start all over from the very top to the bottom. Sherrie's not cutting it and any JCO IV with ten+ years with never having been or tried to be a V or a VI is the penultimate floater in the bowl.

I don't believe that TYC did not adequately inform the community about this youth and his release. Just the whipping boy for a failed state mental health system.

Is it really that the psychiatrist "punished" the youth or "took him off his medications. Really if a youth is prescribed medications and the prescription runs out (yes medications in TYC are still prescribed in 30 day intervals) the youth should not get more medication until they see the psychiatrist. This is no different than in the community. What doctor would continue to prescribe psychoactive medications without the opportunity to monitor the patient. If you were to run out of refills, you wouldn't get any more until you made an appointment. You all make this sound so twisted and abusive when this really is standard mental health practice.

If you have a youth who is not taking their medications properly, maybe they are stashing their medications, why would you continue to give him medication? Medications are like currency in TYC and can also be used for self harm. Claiming that stopping medications is akin to assault is just absolutely uninformed and ridiculous. I hate the knee jerk reactions to TYC on this blog.

Exactly right, 10:14. TYC will always be in the wrong, no matter what happens. And TYC is no good at defending itself. Maybe they don't have time, maybe they know it's a losing battle, maybe they simply don't care to. TYC is certainly constrained by confidentiality when the press is not. Neither is the press constrained by truth and accuracy -- they just quote someone and everyone believes it.

I am not sure the process of the 1550 to discharge a youth, and we all can sit an blame each other, but I think everyone needs to learn from this unfortunate incident. One of the biggest problems that have existed between state and county agencies is the lack of communication and coordination. If a youth is to "mentally ill" to be helped while on probation or in TYC, why are we allowing this youth to be in the community where he can harm himself and others? There should be a mental health hearing to place him in an appropriate secure mental health facility until he is evaluated to be not a threat. Why is this not happening? I may be incorrect in my facts on the 1550, so I apologize now. A teacher was killed and everyone wants to defend and lay blame instead of looking at how this can be prevented in the future.

My husband is going to a mental institution due to psychiatrist and internal medicine doctor taking him off psychotrophic meds, Invega, due to his falling and shaking. Within 6 weeks the falling and shaking had not improved and he was placed in a skilled nursing facility and rehab center. Withdrawal now was causing anger and delussions and hallucinations. He did become angry and abusive 3 times and was sent to a university hospital, where they proceeded to take him off Paxil, and rest of meds for mental illness. They sent him back to the same nursing home only for him within 3 days to get out of control again. He was again taken by police to the local ER. There a male nurse proceeded to tell him not to hit anyone or he would go to jail. He yelled it at my husband and he is lucky he didn't get hit by my husband. He proceeded to tell me my husband was a chronic abuser who was against hemosexuals, which is not true and I said he is not, he just needs his psychotropic meds back, especially Risperdal. He does not hate homosexuals, but his mind had this put in it by a patient in the university hospital and he took it with him back to the nursing home and believed they were all homosexuals who wanted him to have sex with them. He was sent to another hospital and this one, the doctor listened to what I had to say and prescribed risperdal and he is much better. Of course he is court ordered for treatment and will go to a mental health institute. All because of passing the patient. No one cares anymore. Why didn't they at least want to see him weekly for 6 weeks to be sure. I think the docs who took this away should be put in a mental health institute for the same term and see what they learn from their mistakes.

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